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Sacramento Equipment Maintenance Company Inc <br /> 2533 Connie Drive - <br /> Sacramento, CA 95815 .� Calif.Conlr.License/5M77 <br /> (916) 925-2716 wo i 5320' <br /> PLEASE PRINT Data Chart for Tank System Tightness Test stationt S9 <br /> 1. OWNER Property❑ t p 1 <br /> �{ <br /> Ttnkb)❑ Wer"' Address N.pres.ntatlw Tslplarw <br /> Wrns Add" Npres$natM Td$phorw <br /> 2 OPERATOR - t <br /> Nan19 <br /> Address TNptarw <br /> 3. REASON FOR <br /> TEST <br /> (Explaln FulW <br /> 4. WHO REQUESTED *r- <br /> TEST AND WHEN "'"" Tali C-"rw or Anratim <br /> Address Te"hom <br /> Identify by Direction Copscly erarw8upplter Orals APprox.Apo Peff1borean <br /> 5. TANK INVOLVED <br /> Use additional Ina c rri- P7 0 r <br /> IN manifolded tanks rF Xi C1r S)fl" <br /> LocationOftw Ful. vents wpt,or,w r,rp$ <br /> 6. DATA INSTALLATION �,vrS�or' e0ee/Pfr'q `l <br /> Worth tn$Ide drtroway. Cona«o.Black Top. ilce.Tlalts wake.Oro0 iudbn,n.mote <br /> P «shtloyl«a Earth sta Iube$.llama Fe4 Etx$,•Y,raokee WAkh anks7 Make a known <br /> 7. UNDERGROUND laMwe"owr"tank, <br /> WATER ❑ .p <br /> wvn,b rw tivw rag_m�/4. 2 o r10 N2 D �Yes 1l.JM <br /> 8. FILL-UP Tale b w Ietd ttr. Ode AP,,,W W , <br /> ARRANGEMENTS . apad$ arder W7014phn <br /> Wo t.eea. <br /> TenNnsl or oewr oonacl <br /> br actbe or kw ft <br /> y Mans Telphp» <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any oewr ecrtoaclw <br /> {T /j <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Addmww Inbmrtlon on any bar caw OMok"or others b be sdrYsd Whm burp b In porren or eompMMd.vloRors or ebeer$ert prewt e,■rp test,at <br /> Tests wen made on the above tank systems In accordance with test p. ures pnKrlbed for <br /> 11. TEST RESULTS <br /> as detailed on attached test charts with results as follows: <br /> To*Waraaorlos Tlaht he$ksps tnAcesd t Oea Tedd <br /> o „tNi2 <br /> is v w <br /> N tic S j J2 3 <br /> 12 SENSOR 13.This Is to ev"that these tank systems wen tested on the date(s)shown.Those Indicated as"Tlpht"most the cdterle OSU61WW by <br /> CERTIFICATION the National Fin P UctlOn Association Pamphlet 329. <br /> �1����✓ TeolrAolsrr k is Is reponeeoq 01"owrwr end/Or operea a ads ayaare to b"Odisay OVIN state and local swardes a any <br /> O'I' K L 11'1 Ft QC iyl t e M K WOW hawd and the possibility 01 any reportebN pollution to the envkarnerd as s result of the indicated Isles of this <br /> oyetern.Hegar Consultants InOwporated and/or SACRAMENTO EOl11PMENT MAINTENANCE COMPANY,MC.doe$not <br /> TAermal (brr'p, a 7/�/Sl�$39 assum any ity or liability for any by of product to 1119 envlronmeft <br /> Ceraacation s y 1 y 113 f:r. Tank Owner <br /> 101 <br />